An increasing body of literature is developing to indicate neighborhood or contextual factors influence the health of an individual in a community. These studies consider if characteristics within a neighborhood confer health disadvantages or health benefits to its residents, independent of individual characteristics and behavioral patterns. The mechanisms linking neighborhood advantage/disadvantage to better/poorer quality of health care and health outcomes are complex. While millions of Americans fail to receive effective health care, little is known about the impact of these variations in quality of care on population health. This project will apply Evans and Stoddart determinants of health model to examine the effect of contextual factors on health care quality using two AHRQ quality of care indicators: bacterial pneumonia hospitalization rates and pneumonia in patient mortality rates. The research also takes a population based perspective to learn how these two indicators of health care quality affect overall (population based) pneumonia mortality. Specific aims: [unreadable] Aim 1: Examine the variation in bacterial pneumonia hospitalization rates among Texas counties and identify the community characteristics associated with the variation, persons 65+ years. Aim 2: Examine the variation in pneumonia inpatient mortality rates and identify individual, hospital and community factors associated with the variation, for persons 65+ years. Aim 3: Examine the variation in population based mortality rates of pneumonia among Texas counties and determine the effect of primary care (bacterial pneumonia hospitalization rates) and secondary care (pneumonia inpatient mortality rates) on differences in mortality among counties, for persons 65+ years. This study will provide a better understanding of pathways through which community social and physical environments, together with health care quality, influence population health. Such knowledge will inform policy debates and guide better targeted and more effective public health interventions for those adversely impacted by the variability and gaps in health care. [unreadable] [unreadable] [unreadable] [unreadable]